But 2011 snapshot on HIV management in U.S. offers reasons for optimism.

Action Points

Only three Americans in 10 with HIV had the virus under control in a 2011 snapshot of the epidemic, according to the CDC.

Note that in 2011, an estimated 1.2 million people in 50 states and Washington were living with HIV and most of them were aware of their status.

Only three Americans in 10 with HIV had the virus under control in a 2011 snapshot of the epidemic, the CDC is reporting.

And most of those whose virus remained out of control knew they had HIV but were not in medical care, according to a new Vital Signs analysis online inMorbidity and Mortality Weekly Report.

"The findings are important because they show that we have much, much further to go," CDC Director Tom Frieden, MD, told reporters in a media briefing on the report.

"Only three out of 10 Americans living with HIV were documented to have their infections effectively controlled," Frieden said, "and the great majority of those with infections out of control had been diagnosed but were not still in care."

He said the findings were a message to healthcare providers to do more to get people with HIV into care and keep them there. Equally, Frieden said, they are a message to people with HIV to stay in care in order both to protect their own health and to prevent transmission of the virus.

But the director of the CDC's division of HIV/AIDS prevention, Eugene McCray, MD, told MedPage Today the findings also hold some reasons for optimism.

"It's important to keep in mind that today's data are from 2011 and there have been many changes since then," he said. Among those changes are:

In that year, an estimated 1.2 million people in 50 states and Washington were living with HIV and most of them -- some 86% -- were aware of their status.

Data from 18 states and Washington had complete laboratory reporting and were used to estimate linkage to HIV medical care, defined as more documented viral load or CD4-positive T cell count test within 3 months after diagnosis. The analysis included people 13 and older.

Of the 15,449 people with a new HIV diagnosis in those areas, 80% were linked to medical care, with linkage lowest among those ages 13 to 24 (73%) and blacks (76%).

Data from the Medical Monitoring Project were used to estimate the number of people 18 and older who were engaged in care, were prescribed antiretroviral therapy, and had a suppressed viral load.

Analysis showed that, of the 1.2 million with HIV, 40% remained engaged in care, 37% had been prescribed antiretroviral therapy, and 30% achieved viral suppression, defined as a plasma viral load of less than 200 copies of HIV RNA per ml.

Frieden and colleagues focused on the 70% who had not managed to control the virus -- some 839,336 people -- noting that only one in five of those remained undiagnosed.

On the other hand, 66% had been diagnosed but were no longer in care, 4% were in care but had not been prescribed antiretroviral therapy, and 10% had were on medication but had not succeeded in controlling the virus.

"Accessing HIV care can be difficult, particularly for people who lack health insurance or don't have experience navigating what can sometimes be a complex healthcare system," he said.

Also, people with HIV often have other life circumstances -- such as poverty, homelessness, and substance abuse -- that make it hard for them to stay in care, he said.

The rate of viral suppression did not vary markedly by sex of the patient, by race or ethnicity, or by mode of transmission, but it did vary significantly by age.

The prevalence of viral suppression was 37% among those 65 and older, which was significantly higher than among those under 45 -- 13% among those 18-24, 23% among those 25-34, and 27% among those 35-44.

Prevalence among those 45-54 and 55-64 was 34% and 36%, respectively and was not significantly different from the rate among those 65 and older.

The 13% prevalence of viral suppression among those 18-24 is probably associated with a low rate of diagnosis at just 49%, McCray noted.

The analysis was supported by the CDC.

Authors are employees of the agency and disclosed no relevant relationships with industry.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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